Module 6 Flashcards
(163 cards)
1
Q
first line tx for alcohol withdrawal
A
Benzodiazepines
1
Q
What do benzodiazepines end in?
A
-lam and -pam
2
Q
Prototype for alcohol withdrawal is
A
Chlordiazepoxide
3
Q
S/a effects of benzodiazepines
A
Sedation, depression, lethargy, disorientation, and delirium. Paradoxical rxns, lower HR and BP, urticaria, constipation, diarrhea, dry mouth, jaundice, changes in libido, blood dyscrasias
4
Q
How are benzodiazepine doses determined?
A
Institution-specific protocol
Score pt
Seizure precautions
5
Q
Evaluation for benzodiazepines
A
VS WNL, seizures decrease/improve, alcohol withdrawal S/S decrease
6
Q
What is the antidote for too much benzodiazepines?
A
Flumazenil IV
(romazicon)
7
Q
Alcohol use disorder
A
Disulfiram is used as tx
Maintenance of sobriety after initial detox
Adherence=poor
Tablet 125 mg-500 mg dailynon
8
Q
Heroin withdrawal
A
Methadone
Slowly tapered
12 step program
Approved tx center
Naloxone for methadone OD
9
Q
Sedatives- another name
A
Hypnotics
10
Q
What are the two sedative drug classes?
A
Benzodiazepines and non-benzodiazepines (zolpidem )
11
Q
What are the benzodiazepines drugs?
A
Lorazepam, alprazolam, diazepam, halazepam, oxazepam, clonazepam, midazolam
12
Q
Benzodiazepines are used to treat
A
GAD and panic disorder
13
Q
What route and time are benzodiazepines given?
A
IV and scheduled
14
Q
Benzodiazepines are a pregnancy category
A
D
15
Q
Contraindications for benzodiazepines
A
Glaucoma, sleep apnea, and respiratory depression
16
Q
What do benzodiazepines enhance inhibitory effects of
A
GABA in the CNS
17
Q
What routes can benzodiazepines be given?
A
IV and IM
18
Q
Benzodiazepines have a block box warning for
A
Risk of serious a/e if given with opioids
19
Q
Benzodiazepines are widely
A
Abused
20
Q
adverse effects of benzodiazepines
A
Hangover, REM rebound, CNS and respiratory depression, anterograde amnesia, toxicity, paradoxical response, physical dependence, tolerance, withdrawal effects, hypersensitivity
21
Q
Pt teaching for benzodiazepines
A
S/s CNS and respiratory depression
Avoid activities=alertness
Avoid CNS depressants
Report amnesia, paradoxical response,s/s withdrawal
Taper when d/cing
Take before bed, limit continuous use
Sleep hygiene
Avoid grapefruit juice
22
Q
nursing considerations for benzodiazepines
A
Med reconciliation, VS and LOC, toxicity(gastric lavage, activated charcoal, saline cathartics), flumazenil, VS, airway, BP, crash cart, falls precautions, renal function
23
Q
Nonbenzodiazepine drugs
A
Zolpidem, zaleplon, eszopiclone
24
Mechanism of action for non benzodiazepines
Enhances action of GABA in the CNS
25
Side and a/e for non benzodiazepines
Hangover, HA, dizziness, lethargy, anterograde amnesia, memory impairment, ataxia
26
Pt teaching for non benzodiazepines
Take at bedtime, avoid other CNS depressants, sleep hygiene, oral or SL, avoid activities=alertness, be careful with OTC meds, report hangovers
27
Benzodiazepines induce
Sleep(sedation)
28
Nonbenzodiazepines induce
Mild sedation
29
What are the anti epileptic drug classes?
Hydantoins, Benzodiazepines, succinimides, and misc.
30
Hydantoins are a pregnancy category
D
31
Benzodiazepines are a pregnancy category
D (most)
32
Carbamazepine is a pregnancy category
D
33
Valproic acid is a pregnancy category
D
34
Topiramate is a pregnancy category
D
35
Lamotrigine is a pregnancy category
C
36
Gabapentin is a pregnancy category
C
37
What drug did we talk about for Hydantoins
Phenytoin
38
What is phenytoin?
An anticonvulsant
39
Mechanism of action for phenytoin
inhibits sodium influx=decrease/prevents neural firing=raises seizure threshold
40
Phenytoin is ______ _________ ________ (90%)
Highly protein bound
41
Phenytoin is highly protein bound- _____%
90
42
Serum drug levels are affected easily for this drug
Phenytoin
43
What is the therapeutic drug level for phenytoin
10-20mcg/mL
44
Contraindications for phenytoin
Sinus bradycardia, SA block, 2nd and 3rd degree AV block, Adams-stokes syndrome, hypersensitivity
45
Phenytoin black box warning
Cardiac collapse. SI, raised BG levels
46
Side/adverse effects for phenytoin
CNS symptoms, nausea, gingival hyperplasia, blood dyscrasias, osteomalacia, stevens-Johnson syndrome, liver damage, cardiac collapse (IV), endocrine effects
47
Drug interactions for phenytoin
Anticoagulants and aspirin, sulfonamides and cimetidine, oral contraceptives
48
Pt teaching for phenytoin
Similar to other antiseizure meds, take calcium and vitamin D, avoid herbs and OTC meds, take at same time each day
49
Nursing interventions for phenytoin
Monitor serum drug level, mental and Neuro function assess, changes in seizure activity, CBC, BG(DM), give slowly IV, liver dysfunction-LFTs
50
A pt has been prescribed zolpidem for insomnia. Which of the following will the nurse include in the teaching SATA
A.The drug can be safely used for as long as 1 month
B.one of the most common side effects of the drug is HA
C. It should be taken 1 hour to 90 minutes before going to bed
D. This drug should only be used short term 7-10 days
B and D
51
Why should zolpidem be taken immediately?
Induces sleep rapidly
52
How long is zolpidem generally used?
7-10 days
53
What are the comon side/adverse effects of zolpidem?
HA, prolonged drowsiness, dizziness
54
A pt w/ insomnia says she no longer wants to take lorazepam due to AE. What is important info to teach the pt?
A.it will take 2 weeks for the drug to leave the system
B. Symptoms will only improve with med therapy
C.the drug should be tapered gradually to prevent severe withdrawal symptoms
D.d/cing the drug is unwise
C
55
How should withdrawal symptoms be prevented or benzodiazepines?
Tapered in dose and gradually discontinued
56
A pt took too many benzodiazepines and is experiencing toxicity. What med will the nurse plan to admin?
Flumazenil
57
What is the benzodiazepine toxicity antidote?
Flumazenil
58
A pt wishing to detox from heroin has been approved for methadone therapy. What should the nurse teach the pt?
A. You’ll need IV methadone to start
B. You will be able to take 1 week’s worth of methadone home at a time
C. You may take your methadone tablets at any time
D. You have to come here to the clinic to receive your dose of methadone
D
59
Methadone must be taken at the _______ daily
Clinic
60
A pts/ alcohol use d/o has verbalized a desire to stop drinking. The HCP has ordered disulfiram. What teaching is required?
A. Drinking even small amounts of alcohol will cause illness
B. It will prevent you from experiencing any effects of alcohol intake
C. Disulfiram will eliminate your cravings for alcohol
D.you should take the disulfiram promptly if you drink alcohol
A
61
How does disulfiram help patients to stop drinking alcohol?
Unpleasant effects of alcohol and disulfiram together- symptoms can be caused my drinking, cold medicines, mouthwash, or meds with alcohol in them
62
A pt has just been rx carbamazepine. What diagnosis in the pt/s med hx would concern the nurse the most?
A. Kidney dysfunction
B. Sinus bradycardia
C. Bone marrow suppression
D. SA block
C
63
Contraindication for carbamazepine
Bone marrow suppression; carbamazepine has a black box warning for blood dyscrasias
64
A pt is taking phenytoin for a seizure disorder. What adverse effect should the nurse review with the pt?
A.gingival hyperplasia
B. Dependence
C. Peripheral neuropathy
D. Diarrhea
A
65
Pts should be sure to visit their dentist _______ or more frequently if needed bc _________ can cause gingival hyperplasia
Biannually; phenytoin
66
Which medication will interfere with the effectiveness of oral contraceptives?
A. Sumatriptan
B. Acetaminophen
C. Glimepride
D. Phenytoin
D
67
Phenytoin decreases the effectiveness of _______ ________, so the pt will need to use a backup method
Oral contraceptives
68
What pregnancy category is phenytoin?
D
69
Carbamazepine is an
Anticonvulsant metabolized by the liver
Pregnancy category D
Therapeutic blood level is 4-12 mcg/mL
Black box warning: blood dyscrasias, HF, fluid overload
70
Contraindications for carbamazepine
preexisting anemia, agranulocytosis, or liver disease
71
Nursing considerations for carbamazepine
monitor CBC, serum drug level, SI. CNS changes, ECG, electrolytes. Lung sounds and edema, seizure prectations. LFT
72
Pt teaching for carbamazepine
Similar to other antiseizure meds, report dyspnea, bruising, edema in dependent areas, or frequent infections, take before bed.
73
Valproic acid is a
Broad spectrum anti epileptic drug and it is used to treat all type of seizures
74
Mechanism of action for Valproic acid
Increases levels of GABA
75
Therapeutic level for Valproic acid
50-150 mcg/mL
76
T/F: Valproic acid is not highly protein bound
False- it is highly protein bound
77
How is Valproic acid metabolized?
By the liver
78
Side and adverse effects for Valproic acid
GI problems, hepatotoxicity, tremor, weight gain , elevated blood ammonia levels, pancreatitis, SI, or suicidality
79
Pt teaching for Valproic acid
Similar to other antiseizure meds, can take with food
80
Nursing considerations for Valproic acid
CBC, LFT, amylase and lipase, serum drug levels. S/S hepatotoxicity, SI
81
Contraindications for Valproic acid
Those less than 2 years old
Highest risk
82
Gabapentin is used as
An adjunct to treat partial seizures and postherpetic neuralgia
83
Gabapentin mechanism of action
Promotes the release of GABA
84
Side and adverse effects of Gabapentin
CNS effects. Children: viral infection, fever, N/V, somnolence, hostility
85
Nursing considerations for Gabapentin
Assess of neuropsychiatric adverse effects, SI
86
Pt teaching Gabapentin
Similar to other antiseizure meds
87
Succinimides
Used to treat absence seizures
88
Ethosuximide
Anticonvulsant, succinimide
89
Therapeutic blood is 40-100mcg/mL for
Succinimides
90
Therapeutic levels for succinimides
40-100mcg/mL
91
Side and adverse effects of succinimides
Increased frequency of seizures, Stevens-Johnson syndrome, bone marrow suppression, drowsiness, dizziness, lethargy, N/V, SLE, impaired liver or renal function
92
pt teaching for succinimides
Similar as other antiseizure medications, use correct measuring devices, can take with food
93
Nursing considerations for succinimides
CBC, LFT, UA, serum drug levels
94
Phenobarbitals are
Anticonvulsants, sedative-hypnotic/ barbiturates
95
Mechanism of action for phenobarbital
General CNS depressant, stimulates GABA receptors
Not used as first line treatment
Induces hepatic enzyme system which alters metabolism of many other drugs
96
Side and adverse effects of phenobarbital
CNS depression, drowsiness, laryngospams, angioedema, serum sickness, paradoxical effects. Short-term memory deficits in children. Status epilepticus. SI suicidality
97
Nursing considerations for phenobarbital
VS, CBC, LFT, renal function
98
Nursing considerations and pt teaching for anti-seizure medications in general
Monitor serum drug level
Avoid driving
Wear a medic alert ID
Do not abruptly stop
Keep a seizure log
Seizure precations
Hormonal contraceptives are ineffective-barrier
Most are pregnancy category D
Avoid CNS depressants (alcohol)
Avoid grapefruit juice
Monitor for skin rash
Most cause dizziness and drowsiness
99
how do you score a patient for dosing a benzodiazepine
VS and assessment data ,adjust dose every 2hours
100
nonpharmacologic interventions for Parkinson's Disease
increase exercise, fiber, fluids; support group therapy
101
Carbidopa-Levodopa is a drug for
Parkinson's disease
102
levodopa is a
metabolic precursor of dopamine that crosses the blood-brain barrier; dopamine agonist, anti-Parkinson agent
103
Carbidopa is a
dopamine decarboxylase inhibitor that does not cross the blood-brain barrier
104
how does carbidopa work with levodopa
reduces peripheral metabolism of levodopa to increase the amount of levodopa reaches brain; more delivered to CNS in lower doses with carbidopa
105
contraindications for Carbidopa-Levodopa
hypersensitivity, melanoma, closed-angle glaucoma, MAOIs, severe cardiac disease, renal or hepatic disease, dyskinesia, pulmonary disease
106
side effects for carbidopa-levodopa
N/V, anticholinergic effects, dyskinesia (at high doses), sweat and urine may turn red, brown, or black(expected)
107
adverse effects of carbidopa-levodopa
orthostatic hypotension, angioedema, palpitations, psychosis, depression, SI, agranulocytosis, dysrhythmias, neuroleptic malignant syndrome (if stopped abruptly)
108
pt teaching for carbidopa-levodopa
do not stop taking abruptly, eat food after taking it ad avoid high protein (decreases absorption), change positions slowly, avoid activities requiring alertness, good oral hygiene, avoid multivitamins involving iron and B6 (pyroxamine)-> decrease med effectiveness, darkening of urine is ok, notify HCP of a/e, increase fiber, fluids, exercise, on/off syndrome, risk for injury/falls
109
what is on/off syndrome?
med wears off and dopamine levels become low between doses=Parkinson's s/s
110
what a/e should a pt report to HCP for carbidopa-levodopa
palpitations, urinary retention, involuntary movmts, behavioral changes, severe N/V, new skin lesions
111
interventions for cardbidopa-levodopa
monitor VS, I&O, assess and treat constipation, monitor LFT and RFT, monitor for toxicity and agranulocytosis (CBC with diff)
112
s/s of carbidopa-levodopa toxicity
involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of tongue and behavioral changes
113
Ripinirole is a
dopamine agonist/anti-Parkinson agent used for management in monotherapy or adjunctive therapy with carbidopa-levodopa; also tx for restless leg syndrome
114
side and adverse effects of ripinirole
sudden inability to stay awake, daytime sleepiness, orthostatic hypotension, psychosis, impulse control disorder, dyskinesia, nausea
115
interventions and teaching for ropinirole
take as directed, report drowsiness/daytime sleepiness
avoid CNS depressants
change positions slowly
use good oral hygiene (dry mouth= gum and candies)
report hallucinations and/or nightmares
report uncontrollable urges (i.e. gamble)
116
Benztropine is a
anticholinergic/ anti-Parkinson agent used for adjunctive tx for all forms of Parkinson's disease
117
mechanism of action for benztropine
blocks cholinergic action in the CNS
118
Benztropine is used to trat
all forms of Parkinson's disease including drug induced extrapyramidal effects nd acute dystonic rxn
119
side and adverse effects for benztropine
N/V, anticholinergic effects, antihistamine effects(sedation)
120
pt teaching for benztropine
take with food, inc fiber fluid and exercise , report urinary retention, oral hygiene, avoid CNS depressants, avoid activities that require alertnessn
121
nursing considerations for benztropine
avoid giving to older adults (BEER's criteria), monitor I&O (constipation and urinary retention)
122
what are the Parkinson's disease drugs
Carbidopa-Levodopa,Ropinirole,Benztropine,
123
drug for Alzheimer's disease
Donepezil
124
Donepezil is a
anti-Alzheimer agent/cholinergic, Acetylcholinesterase enzyme inhibitors aka reversible cholinesterase inhibitor
125
Donepezil is used to treat
mild-to - moderate dementia associated with Alzheimer's disease
126
mechanism of action for donepezil
improves cholinergic function, prevent cholinesterase from inactivating acetylcholine
127
side and adverse effects of donepezil
excessive muscarinic stimulation, increased respiratory secretions, cholinergic crisis, peptic ulcers SLUDGES
128
what is cholinergic crisis treated with?
atropine
129
pt teaching for donepezil
report s/s GI bleed, report s/s cholinergic crisis. Does not cure Alzheimer disease, take before bed
130
nursing considerations for donepezil
assess for improvement in cognitive function. crash cart in case of cholinergic crisis and ventilation may be needed
131
neostigmine is a drug for
myasthenia gravis; can diagnose MG and reverse neuromuscular blockade
132
mechanism of action for neostigmine
indirect acting cholinergic agonists, reversible cholinesterase inhibitor
133
contraindications for neostigmine
GI obstruction, ileus, urinary tract obstruction, peritonitis
134
use neostigmine cautiously in those with
peptic ulcer disease, hypothyroidism, seizure disorder and those with hypotension and bradycardia
135
side and adverse effects for neostigmine
excessive muscarinic stimulation (increase secretions, GI motility, diaphoresis, salivation, urinary urgency, cholinergic crisis (biggest adverse effect)
136
cholinergic crisis S/S
respiratory depression and paralysis of respiratory muscles; increase GI motility, bradycardia, muscle constriction, pupillary constriction, increased sweating and salivation
137
what do you treat cholinergic crisis with
atropine
138
myasthenic crisis
muscle weakness that becomes pronounced and can lead to quadriparesis, quadriplegia, SOB, respiratory insufficiency and difficulty swallowing
139
myasthenic crisis is a result of
undermedication
140
cholinergic crisis is a result of
overmedication
141
nursing considerations for neostigmine
antidote is atropine
cholinergic crisis--> crash cart and mechanical ventilation
bedpan/urinal--> sphincter control decreases bc of cholinergic
teach s/s of over/under medication
142
what can you administer to determine whether it is myasthenic or cholinergic crisis
edrophonium (a cholinergic) via IV
if s/s worsens, pt needs antidote (atropine)
if s/s improve, pt needs more cholinergic (myasthenic crisis)
143
drugs for muscle spasms are also classified as
central-acting muscle relaxants because they affect the CNS
144
examples of central-acting muscle relaxant drugs
baclofen
dantrolene
cyclobenzaprine
145
central-acting muscle relaxants cause
decrease in pain, increased ROM, dependence (DO NOT ABRUPTLY STOP)
146
side and adverse effects of muscle relaxants
CNS depression
147
dantrolene has an adverse effect of
hepatotoxicity
148
central-acting muscle relaxants can cause
drowsiness, sedation, dizzinessn
149
nursing interventions for muscle spasm drugs
monitor VS, dizziness, lightheadedness, avoid driving and CNS depressants, monitor LFT, monitor for constipation and urinary retention, take with food, increase fiber and fluids
150
why can a pt not directly stop central-acting muscle relaxers?
rebound spasms, hallucinations, seizures
151
Neuromuscular blocking drug
succinylcholine(depolarizing)
152
what does succinylcholine do?
mimics Acetylcholine preventing it from binding with its receptors
153
succinylcholine is
a short-acting paralytic
154
fun fact about succinylcholine
only depolarizing agent in the United States
155
antidote for succinylcholine
neostigmine
156
what is succinycholine used for
emergent ventilation and intubation
157
if given IV succinylcholine
causes complete muscle relaxation in 30 sec- 1 min for 2-3 min
158
Non-depolarizing neuromuscular blocking drugs
pancuronium and vancuronium (adjunct to general anesthesia)
159
side/adverse effects for neuromuscular blocking drugs
respiratory arrest(paralyzed resp muscles)
muscle pain (12-24 hrs after d/c)
malignant hyperthermia
hyperkalemia
160
malignant hyperthermia
stop med, oxygen at 100%, decrease body temp, administer dantrolene
161
T/F: neuromuscular blocking drugs DO NOT affect hearing, thinking, or the ability to feel pain
true
162
